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50
J Med Ethics; Medical Humanities 2005;31:50
Education & Debate
...................................................................
The Humanities in Medicine – Distancing and the distance
between us
I
n the first issue of this journal
Greaves and Evans1 characterised the
medical humanities as a spectrum
with an additive view of the relationship
between humanities disciplines and
medicine at one end and an integrated
view at the other. The first part of the
paper by Louis-Courvoisier and Wenger2
represents a good example of the integrated view of medical humanities,
addressing as it does a theoretical
underpinning for the inclusion of the
teaching of history and literature in
medical education, the practical value
of this teaching for medical students
and the tools provided by these disciplines to the teaching of medical students. The second part of the paper
deals with the difficulties both actual
and potential for teachers in delivering
such a programme. The discussion of
these areas is based on their own
experience but may have much wider
currency and provide a detailed reflective account of areas of importance to
the place of Medical Humanities in
medical education.
The main theoretical concept that
they claim is common to all the humanities disciplines is that of ‘‘distancing’’,
by which they appear to mean that they
are all involved with investigating the
gap between an object and how we
understand that object. They distinguish
two types of gap: the diachronic temporal
gap exemplified by historical investigations and the synchronic gap between an
idea and the expression of that idea in
language as exemplified by literary
studies. However, whichever discipline
is considered, there are bound to be both
diachronic and synchronic aspects to
any such gap. What is key is that they all
involve achieving an understanding of
the object which is ‘‘context dependant
and culturally shaped’’. In other words
recognising what Gadamer3 termed the
horizons of understanding and eventually achieving a shared understanding
where possible. Their claim that ‘‘distancing’’ is common to all humanities
disciplines seems reasonable but is it the
most important concept in relation to
the place of humanities in medical
education?
www.medicalhumanities.com
This idea of ‘‘distancing’’ could be
seen to have both an ‘‘instrumental’’ and ‘‘non-instrumental’’ value in
medical education as described by
Macnaughton.4 In her discussion of the
non-instrumental value of the humanities in medical education she identifies the notion of education, as opposed
to medical training, as being a valued
outcome of the humanities in medical
education along with personal development and opportunities to experience
a counter-culture to medicine. Each
of these three could be fostered by
‘‘distancing’’. However, it is predominantly the instrumental value of the
humanities that is the concern of
Louis-Courvoisier and Wenger.2 They
identify similar instrumental values to
Macnaughton; such as providing a
reservoir of vicarious experience,
improving analytical and communication skills and improving skills in the
construction of arguments. However,
they also include the development of
specific narrative competences. At first
glance this emphasis on the skills of
literary criticism may seem excessive
for teaching medical students in the
context of what they describe as a
compulsory course but the arguments
they put for its importance seem compelling. It is both consistent with the
underpinning concept of ‘‘distancing’’
but also with the increasing acknowledgement of the importance of narrative
in medicine.5 6
Distance, and bridging it, seem to be
the key to the practical difficulties for
teachers discussed in the second part of
their paper. They identify four important gaps, which may occur when
humanities are included in medical
education. The first three gaps (for
example, differences in the questions,
methods, and language of the humanities and medicine; differences in the
pedagogical cultures of humanities and
medical faculties; and lack of understanding of medical culture by humanities scholars) are problems inherent in
humanities scholars teaching within a
medical curriculum. The fourth, that of
the distance which teaching humanities
within the medical environment may
put between humanities scholars and
their own discipline, is a consequence of
the medical humanities project in medical education. The logic of the solutions
proposed seem both necessary and
pragmatic but somewhat one sided. As
an enthusiast for medical humanities
with a background in medicine I am
conscious that it is easy for the charge of
medical imperialism to be brought.
If the distance between the humanities and medicine is to be bridged in
medical education then pragmatic solutions must involve mutual respect. Team
teaching has much to recommend it as a
bridge. But for it to be a strong bridge,
educators from both the humanities and
medicine need to make the effort to
understand each others’ cultures. If the
fourth gap is to be overcome it is
important that those making appointments to medical humanities posts in
medical schools negotiate appropriate
joint appointments for scholars from the
humanities. If the distance between us
can be bridged with respect then
Pellagrino’s ideal of ‘‘double belonging’’7
will be truly possible within medical
education.
Richard Meakin
Dept of Primary Care and Population Science,
Royal Free & University College
Medical School, Archway Campus,
2nd Floor Holborn Union, Building, Highgate
Hill, London N19 3UA,
r.meakin@pcps.ucl.ac.uk
REFERENCES
1 Greaves D, Evans M. Medical humanities. J Med
Ethics; Medical Humanities 2000;26:1–2.
2 Louis-Courvoisier M, Wegner A. How to make
the most of history and literature in the teaching
of medical humanities? The experience of
Geneva. J Med Ethics; Medical Humanities
2005;31:51–4.
3 Gadamer H-G. Truth and Method. London: Sheed
and Ward, 1979.
4 Macnaughton J. The humanities in medical
education: context, outcomes and structures.
J Med Ethics; Medical Humanities
2000;26:23–30.
5 Hunter KM. Doctor’s stories: The narrative
structure of medical knowledge. New Jersey:
Princeton University Press, 1991.
6 Greenhagh T, Hurwitz B, eds. Narrative Based
Medicine. London: BMJ Publishing, 1998.
7 Pellegrino ED. Humanism and the Physician.
Knoxville: The University of Tennessee Press,
1979.
Downloaded from http://mh.bmj.com/ on May 27, 2016 - Published by group.bmj.com
The Humanities in Medicine − Distancing and
the distance between us
Richard Meakin
Med Humanities 2005 31: 50
doi: 10.1136/jme.200X.000210
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